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Biomedical subjects

I Fietze

Publications and source records attributed to I Fietze.

27 records · Page 2Linked to original sources
PubMed1996

Diagnosis of alveolitis in interstitial lung manifestation in connective tissue diseases: importance of late inspiratory crackles, 67 gallium scan and bronchoalveolar lavage.

The diagnostic relevance of bronchoalveolar lavage (BAL) and associated non-invasive findings in connective tissue diseases (CTD) has not been established regarding alveolitis so far. The goal of the study was to determine the relations between BAL cell differential count and findings of non-invasive diagnostic procedures for alveolitis to predict the clinical value of BAL in CTD. One hundred-five patients (92 non-smokers; 13 smokers) with CTD (73 patients with systemic sclerosis, 19 with systemic lupus erythematosus, 13 with primary Sjögren's syndrome) had symptoms or signs of lung involvement and were further examined (lung function test, chest radiography, thoracic computed tomography, 67 gallium scintigraphy and BAL). The relations between BAL in middle lobe and cell count differentiation to non-invasive investigations were analyzed by logistic regression. In all CTD patients investigated a pulmonal involvement occurred based on non-invasive methods. Regarding non-invasive methods, alveolitis determined by BAL cell differential count was significantly associated with an increased 67-gallium uptake and late inspiratory crackles (P < 0.01), and to a lesser extent with an abnormal interstitial pattern in CT (P < 0.055). Parameters of lung function and laboratory parameters were related to alveolitis using multivariate testing. Considering the alveolitis subtype (granulo- or lymphocytosis), only a reduced FEV1 showed a relationship to granulocytic alveolitis (P < 0.01). Late inspiratory crackles and increased 67 gallium uptake as non-invasive diagnostic findings point out alveolitis in CTD remarkably. Therapeutic and prognostic aspects necessitate BAL to specify the type of alveolitis (lymphocytosis or granulocytosis or mixed forms) in CTD patients with lung manifestation. Non-invasive diagnostic procedures cannot predict the type of alveolitis sufficiently.

Adult↗
PubMed1995

[Differentiation of arousal in sleep before and after CPAP therapy in patients with pronounced sleep apnea syndrome].

The sleep apnea syndrome is often associated with the syndromes of daytime exhaustion and involuntary daytime sleeping fits. The cause is assumed to be fragmentary sleep resulting from night-time arousal. The central nervous activation reactions caused by apnea or hypopnea, respectively, and not the movement arousal determine the sleep structure. We have examined 10 male patients in the age range 40-55 years (48 +/- 6 SD) before and during the first 3 nights of CPAP therapy. Cardiorespiratory polysomnography was performed in all four nights. Sleep way analyzed visually and differentiation was made between respiratory (RA) and movement arousal (MA). All 10 patients had a pronounced sleep apnea syndrome. Deep and dream sleep were reduced, significantly more respiratory arousals occurred than movement arousals. The SWS latency was shortened in the first therapy night, the deep and dream sleep proportions increased and the RA decreased significantly. No further significant changes in the sleep parameters occurred during the second and third nights. We found that the number of apnea/hypopnea was not equal to the number of RA. When less arousal was recognized it was suggestive of a deficit of the diversion function while more RA was indicative of additional respiratory events, e.g. pharyngeal obstructions and hyperventilations which were not recognized as apnea or hypopnea. In addition to its role in the differential diagnosis of sleeping disorders, in particular sleep apnea, arousal differentiation is also an important criterion for estimating the efficiency of CPAP therapy.

Adult↗
PubMed1995

[Obstructive snoring--diagnosis and therapy].

Obstructive snoring belongs to the sleep-related breathing disorders. The characteristics of this disorder is described, following the case report about two young snorers, complaining of excessive day-time sleepiness, involuntary falling asleep in monotoneous situations. Ambulatory monitoring using the four-channel system MESAM-IV showed a Respiratory Disturbance Index of < 5 during a predominantly continuous snoring episode without significant drops in oxygen saturation. Clinical cardio-respiratoric polysomnographic monitoring showed a normal architecture of sleep interrupted by respiratory arousals. Under nasal CPAP treatment these arousals, as well as the complained excessive daytime sleepiness disappeared. The latter fact becomes evident, when comparing the sleep latencies before therapy to those under CPAP-treatment, estimated by the Multiple Sleep Latency Test (MSLT). Thus, this therapy proved to be very effective in patients suffering from obstructive snoring.

Adult↗
PubMed1993

[Therapeutic consequences of obstructive sleep apnea syndrome--results of drug, mechanical and surgical treatment].

The therapeutical strategy of the obstructive sleep apnoea syndrome depends on the differential diagnosis of the sleep disorder, the subjective complaints and the patients' individual cardiopulmonary risk profile. Basic requirements for a successful treatment are stepped concepts for therapy. Initial therapeutical methods are preventive measures such as adequate sleep hygiene, weight loss, and reduction of alcoholic intake. We investigated the effectiveness of following therapeutical methods: drug treatment, nasal CPAP therapy and surgical approach. We present the results of the first 151 treated patients aged between 15 and 88 years (mean: 50.8 +/- 11.5 SD). 20 patients with an apnoea index below 20 per hour were treated with theophylline. After 4 weeks with theophylline there were no significant changes in apnoea index, O2 saturation and snoring level. 24 patients themselves preferred the Uvulopalatopharyngoplasty (UPPP). 8 weeks after surgical approach we couldn't find significant changes in the apnoea index although 11 of these patients reported on a better sleep quality. 107 patients were treated with nasal CPAP. The effective CPAP pressures were between 6 and 14.5 mbar. Long term compliance with CPAP was studied in a survey of 70 patients who underwent a CPAP trial. After 6 months 97% were complaint, 17% of them additionally were using a humidifier. Our data show that effective therapy can be achieved with nCPAP objectively and subjectively. Other methods--theophylline and UPPP--are less successful. CPAP is likely to remain the first choice for treatment of sleep related breathing disorders and it should be applied more generously.

Adolescent↗
PubMed1993

[Diagnostic findings in patients with obstructive sleep apnea syndrome in nCPAP therapy].

The outpatient measurement with the ME-SAM IC system, including the analysis of heart rate, respiration sounds, continuous oxygen saturation and body position, is an important part in a stepped concept for diagnosis and therapy of patients with an obstructive sleep apnea syndrome (OSAS). We investigated the importance of these parameters as well as age and Broca in relation to the continuous positive airway pressure determined in the sleep laboratory. In this study we present the first 60 patients (56 m, 4 f) treated successfully with nCPAP. The mean age was 53.1 +/- 8.6 years, the Broca Index 133.6 +/- 22.9, the respiratory disturbance index (RDI, apnea + hypopnea index) 48.1 +/- 22.7, the mean nocturnal oxygen saturation 90.4 +/- 3.8% and the mean minimal oxygen saturation 84.4 +/- 4.2%. We found positive significant correlation between Broca, RDI and oxygen saturation as well as between Broca and age. The mean effective continuous positive airway pressure was 9.7 +/- 2.1 cm H2O in our group of OSAS patients. With an increase in RDI and with a decrease in age and oxygen saturation we found an significant increase in the effective continuous positive airway pressure. A positive correlation between Broca and air pressure could be seen, but was not significant. Our data show that there is a strong correlation between constitution, the outpatient measurement with MESAM-system and the effective positive airway pressure in patients with a pronounced obstructive sleep apnea syndrome (RDI > 15 and marked clinical symptoms). The knowledge about these relationships should be considered in the nCPAP therapy and during the long term medical care of treated patients.

Adult↗
PubMed1993

[Measuring circadian core temperature periodicity without masking in obstructive sleep apnea].

Although close interactions between sleep respectively sleep disturbances and the circadian system are known, chronobiological aspects have not been taken into account sufficiently in investigation and therapy of obstructive sleep apnea (OSA). We carried out a 24-hours lasting constant routine. Considering the circadian course of core temperature, patients with OSA show an impairment of the circadian system, which improves after three nights with nCPAP-treatment.

Adult↗
PubMed1991

[Relationship between insomnia and arterial hypotension].

The relations between insomnia and blood pressure were investigated in 151 patients (56 men and 95 women). It was found that 37.1% of the patients were normotensive, whereas 31.8% suffered from arterial hypertension and 31.1% from arterial hypotension. There was practically no difference between normotensives and hypertensives in respect of disturbed behavioral patterns of sleep, but an entirely different picture was presented by the arterial hypotensives. Characteristic features of hypotonic insomnias were (mostly in women) prolonged time before falling asleep, frequent awakening at night associated with tachycardia and long-lasting increased excitability, starting difficulties in the morning, depressive conditions, compulsive yawning and falling asleep during daytime, tiredness, lack of "drive" and reduced physical and mental efficiency. This pattern of signs and symptoms was enhanced by hypnotics and tranquilisers. During sleep blood pressures down to 50/35 Torr were measured. It is assumed that the low blood pressure results in hypoxic and hypoglycaemic conditions in the brain. Spontaneous awakening is considered to be an emergency reaction triggered by the deficient cerebral blood flow.

Adult↗